C. Robert Cloninger, Dragan M. Svrakic (2016)
Personality disorder (PD) is the primary psychiatric illness observed in most patients with psychosocial complaints, particularly young adults. PD is present in one-sixth of people in the general population and more than half of all psychiatric patients. Reliable diagnosis of PD can be made in routine clinical practice by brief assessment of two essential features of a person’s character—low self-directedness and low cooperativeness—that indicate reduced ability to work and to get along with other people. Subtypes can be distinguished in terms of configurations of temperament traits measuring a person’s emotional drives for immediate gratification. PD is usually a lifelong disorder but can mature (remit) spontaneously or with treatment. The temperament and character components of PD are all moderately heritable. Neurobiological findings about personality explain the benefit of differential pharmacotherapy and psychotherapy for different subtypes of PD. The treatment of PD often begins with a stabilization phase with medications and simple cognitive-behavioral approaches. Even in cases of severe PD, more advanced stages of therapy can lead to radical transformation of a person’s perspective on life leading to a healthy and stable state of well-being.